Pharmaceuticals’ Influence On Clinical Practice Guidelines Exposed

Sometimes research reveals startling new information that radically changes the way we look at the world. Other times, research upends conventional wisdom, debunking a long-held belief.

Then, there are those times when research simply confirms what we knew all along.

An article published in the Journal of the American Medical Association concludes, 'there appears to be considerable interaction between clinical practice guideline (CPG) authors and the pharmaceutical industry.'

The conclusion would be funny if it weren't so sad.

Mainstream research lends credence to an age-old alternative objection

My initial reactions to this study ranged from a sarcastic 'Wow, do you really think so?' to a frustrated 'Where have you BEEN!?!' But when those first feelings had subsided, I realised the importance of this research: it proves what many in the alternative medicine world have been saying for years - and does so through the most mainstream of mainstream channels.

In this study, doctors from hospitals in Toronto, Ontario, and Boston, Massachusetts set out to 'quantify the extent and nature of interactions between authors of CPGs and the pharmaceutical industry.'

What are CPGs? They are 'clinical practice guidelines,' a sort of encyclopedia of treatment recommendations for just about every health condition under the sun. According to the study, CPGs are intended to 'present a synthesis of current evidence and recommendations preformed by expert clinicians.' And, as the study's authors go on to say, '...[CPGs] may affect the practice of a large number of physicians.'

So the researchers dug through North American and European CPGs written between 1991 and 1999. To be included, the CPG had to be endorsed by a major North American or European medical society, the authors had to be identifiable and available, and the condition it covered had to be common and treatable with drugs. In the end, 44 CPGs were identified for inclusion in the study. Those CPGs covered 10 common adult diseases: asthma, coronary artery disease, heart failure, depression, diabetes, peptic ulcer disease, high cholesterol, hypertension, osteoarthritis, and pneumonia.

Author-docs at high risk for 'Who, me?' syndrome

After they identified the CPGs, the researchers mailed a survey to 176 of the CPGs' authors (16 of the original authors either could not be located or had died). In all, 107 authors responded to the survey - and their responses were quite telling.

The overwhelming majority of the responders (87%) had some relationship to the pharmaceutical industry. More than half (58%) had received research funding from drug companies, and more than one-third (38%) had at one time been an employee or served as a consultant.

But here's the really revealing finding: according to the study, '59 percent of authors had relationships with companies whose products were specifically considered or included in the guideline they authored.' And nearly all of those relationships (96%) were already in place when the doctors were selected to author the guidelines.

Interestingly, only seven percent of the doctors surveyed believed that their own treatment recommendations were influenced by their pharmaceutical industry relationships - but nearly 20 percent said that their co-authors' input was tainted by their own drug company ties.

Study's weaknesses may actually strengthen the argument

The study admits that the sample size was small and the response rate less than ideal. But, the researchers suggest that these limitations may actually cause the study to minimise the influence of the pharmaceutical industry on clinical practice guidelines.

They note that doctors who did not respond may have been wary of revealing their level of involvement, in light of increasing attention on the issue. Plus, the survey cover letter did not guarantee anonymity. Based on these factors, the study concludes 'it is possible that non-respondents actually had a higher degree of interaction with the pharmaceutical industry than respondents.'

Knowing what's influencing your doctor, and those developing the clinical recommendations, is critical when weighing your treatment options. You and I don't need a JAMA study to tell us that mainstream medicine is influenced by the pharmaceutical industry. This study is being widely reported in mainstream media headlines all across the country. Maybe that's what it will take to get other people to wake up to this issue.